A Safer Way to Get a Coronary Angiogram?

Research finds that the arm access point to the heart may prevent bleeding and death.

By Victoria Candland
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Research suggests that the arm may be a safer access point for catheter-based heart procedures because it has a lower risk of major bleeding and death. The leaders of this study are calling for a reevaluation of clinical guidelines for catheter-based heart procedures including coronary angiograms.

The study randomized more than 8,400 coronary angiogram patients to receive the procedure through a catheter either in their arm, called the radial approach, or the groin, called the femoral approach. All of these patients had some form of acute coronary syndrome, “an umbrella term for situations where the blood supplied to the heart muscle is suddenly blocked,” like a heart attack or unstable angina, according to the American Heart Association.

Those who had the radial approach, through the arm, had significantly less major bleeding and death than those who had the femoral approach, through the groin.

Interventional cardiologists often perform a coronary angiogram on patients with acute coronary syndrome. This operation assesses the blockages in the heart’s arteries, and does so by accessing an artery either in the arm or groin and inserting a catheter with small tools on it, which goes all the way into the heart. If a blockage is found inside the heart, the cardiologist often uses the same catheter to inflate or expand a small device that pushes away plaque and better opens the artery. This technique is called angioplasty. Sometimes a small tube called a stent is placed in the artery to keep it open.

Coronary angiograms are performed on more than 1 million people in the United States each year, and the most popular access point is through the artery in the groin. The arm access point is rarely used right now in the United States — American cardiologists use it for less than 15 percent of cases.

But the lead author of the study, Marco Valgimigli, MD, PhD, associate professor of cardiology and senior interventional cardiologist at the Erasmus University Medical Center, is trying to bring the radial approach to the forefront of these heart procedures. He says, “I believe the evidence from our study should compel a switch to the radial approach as the preferred method. I hope that a new generation of interventional cardiologists will be specifically trained in the radial approach and that more medical centers will build up their expertise in this procedure.”

Cardiologists tend to prefer the femoral approach because the artery by the groin is larger and less prone to spasms, which makes it easier to move medical equipment through the catheter. In addition, the radial approach requires more technical skill and smaller equipment.

However, Dr.Valgimigli says that the radial approach for coronary angiograms saves on medical costs since the patients usually have a quicker recovery and shorter hospital stay.

“This study shows that interventional cardiologists who are experienced with the radial approach have nothing to lose and everything to gain by using the arm as the access point for these procedures,” Dr. Valgimigli commented.